Iowa Mandate for Electronic Transmission of Prescriptions

From the State of Iowa.  Hat Tip: Dr. Menadue.

The Board of Pharmacy recently adopted final rulemaking to implement 2018 Iowa Acts, House File 2377, which mandates the electronic transmission of all prescriptions not subject to an exception as of January 1, 2020. The Board’s rules were published in the Iowa Administrative Bulletin on July 31, 2019 and became effective September 4, 2019. 
The adopted rules provide additional clarification on what constitutes an “emergency situation.” Specifically, “an emergency situation may include, but is not limited to, the issuance of a prescription to meet the immediate care need of a patient after hours when a prescriber is unable to access electronic prescribing capabilities. Such prescription shall be limited to a quantity sufficient to meet the acute need of the patient with no authorized refills.”
Prescribers and pharmacies who wish to seek exemption must submit a completed petition request by October 1, 2019. The petition request form may be found on the Board’s website HERE. Only completed petition requests will be considered for exemption. Attached to the petition request form is information from vendors of electronic prescribing systems who may be able to meet your electronic prescribing needs. The Board does not endorse any particular vendor and practitioners are not limited to the vendors whose information is provided. Note that the Board does not require electronic health record (EHR) systems, nor does it require an electronic prescribing system be integrated into an EHR system. 
Administrative penalties for noncompliance. Violations of the electronic transmission mandate may result in an administrative penalty of $250 per violation, up to a maximum of $5,000 per calendar year. While a pharmacy must be capable of receiving electronic prescriptions, including for controlled substances, a pharmacist may fill a prescription received by hardcopy, fax, or phone without verifying the prescriber has a valid exemption to the mandate.
For more information, including frequently asked questions, concerning the mandate please visit the Board’s website at
The Board of Pharmacy strongly encourages practitioners and pharmacies to review the information provided on the website before contacting the Board.
If practitioners or pharmacies have a complaint regarding the mandate it is recommended that you contact your legislator.
For all other questions please contact Amanda Woltz at 515-281-6674 or

It really is hard to sleep in the ER

From Reuters:

Patients who spend the night in the emergency room may get much less rest than patients who sleep in beds in hospital rooms, a small study suggests.

For the study, researchers surveyed 49 emergency room patients waiting to be admitted to the hospital and 44 people already admitted to inpatient wards. They asked the patients to describe noise levels in their rooms and rate sleep quality on a scale from 1 to 100, from worst to best. The questions focused on five aspects: how lightly or deeply they slept; how easily they fell asleep; how often they awoke during the night; how easily they returned to sleep when they did wake up; and whether they thought they had a good or bad night’s sleep.

After researchers accounted for patient characteristics that might impact sleep like their age and the severity of their illness or injury, they still found that people who got inpatient rooms rated their sleep environment as 65% quieter than patients stuck in the ER for the night.

Extended ED Mental Health Care Now Reportable as Observation

From ACEP Now:

We asked CPT for direction on how to report days two and three of that stay. As published in the July 2019 issue of CPT Assistant, the AMA instructs physicians to report the appropriate ED E/M code, initial observation code (99218–99220) or critical care code, depending on the chart documentation, for the first day in the emergency department. For day two, CPT instructs us to use a subsequent observation day code (99224–99226) to capture the middle day (or multiple days) of a prolonged behavioral health stay in the ED setting. On the day of discharge from the ED setting, the discharging physician should report the appropriate subsequent observation day or the discharge from observation code (99217) based on the level of service documented.

Of note: Third party payment policies and unique contractual language may differ from CPT coding direction.

These new directions from CPT are helpful, as previously there was no way to report the extra days of care for the patients described here.

Air ambulance advisory panel on surprise billing takes shape

From Healthcare Dive:

  • The Department of Transportation appointed 13 members to a new advisory committee charged with reviewing issues in the air ambulance industry with a special focus on finding ways to protect consumers from surprise billing.
  • The newly formed board is made up of professionals and stakeholders representing insurers, physicians, state insurance regulators and air ambulance providers.
  • After the committee’s first meeting, the group will have 180 days to deliver a report to the DOT secretary and HHS about their recommendations on various issues including surprise billing.

One killed after man intentionally crashes into Ohio emergency room

From ABC15:

One person is dead and two are injured after police say a man intentionally crashed his truck into the emergency room of an Ohio hospital Friday.

The driver of the truck is in custody and being treated for injuries, said Fairfield County Sheriff’s Office Deputy Chief Alex Lape. Charges are expected against the driver because there was no indication the driver attempted to brake.

“From all appearances, it looks like it was a deliberate act,” Lape said

Man being treated in emergency room ran away, then fell off cliff

From KUSI:

A man who was being treated in the emergency room of UC San Diego Medical Center Hillcrest escaped today and fell off a nearby cliff, fire officials said.

Firefighters rescued the man and returned him to the hospital for treatment of a broken arm and leg.


ED Docs Can Identify Patients Likely to Die Within 1 Month

From Medscape:

Emergency department (ED) physicians who answered the question “Would you be surprised if your patient died in the next 1 month?” could identify patients over age 65 years who indeed died within a month, according to results of a study published online September 13 in JAMA Network Open.